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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Health Services Research 1/2018

Teledermatology scale-up frameworks: a structured review and critique

BMC Health Services Research > Ausgabe 1/2018
Laticha Elizabeth Marolana Walters, Richard Ernest Scott, Maurice Mars
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12913-018-3418-x) contains supplementary material, which is available to authorized users.



The South African public health sector embarked on a National Telemedicine System implementation program in 1999 and although unsuccessful, the Province of KwaZulu-Natal subsequently implemented teledermatology in 2003, with two currently active services (synchronous and asynchronous). Although sustained these have not been scaled-up to meet the needs of all hospitals in the Province. A recent teledermatology scale-up design requirements elicitation process within KwaZulu-Natal confirmed the need for a framework, and identified requirements through key stakeholders, programme observations, the literature, and experts. This study aimed to identify and characterise existing teledermatology or related eHealth scale-up frameworks, determine whether any met the previously elicited scale-up framework requirements, and were suitable for use in the KwaZulu-Natal public health sector.


A structured literature search was performed of electronic databases (Scopus, Science Direct, IEEE, PubMed, and Google Scholar) seeking proposed or developed teledermatology or related scale-up frameworks. Global public health publications were also hand-searched. The teledermatology or telemedicine, telehealth or eHealth related scale-up frameworks identified were critiqued against the previously elicited teledermatology scale-up framework requirements to determine their suitability for use.


No specific teledermatology scale-up framework was found. Seven related scale-up frameworks were identified, although none met all the previously identified teledermatology scale-up framework requirements. The identified frameworks were designed for specific scale-up phases and lacked a more holistic and comprehensive approach.


There is an evidenced-based need for the development of a health sector aligned, holistic framework that meets the identified teledermatology scale-up framework requirements. The findings of this paper will inform development of such a framework.
Additional file 1: Details of characterisation of the identified frameworks. Detailed listing of characterisation of identified frameworks split into Abbreviation, Research methods, Theoretical foundations, Components, Considerations and relationships, Real-world implementation; (DOCX 240 kb)
Additional file 2: Detailed results of the TD requirements mapping to identified frameworks. Detailed listing of the results of the TD requirements mapping to the components of the identified frameworks (DOCX 248 kb)
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